• Pigmentation affecting cheeks, forehead, upper lip, nose and chin
  • More common in females
  • More noticeable in the summer and improves during winter months
  • Birth control pills and hormone therapy can be a trigger
  • Management is challenging
  • A combination of therapies provides best clinical outcome
  • A mixture of hydroquinone, hydrocortisone and tretinoin can be safely and effectively used for limited amount of time
  • Non-hydroquinone skin lighteners are an alternative to patients that don’t tolerate or have allergy to hydroquinone